This three-year application will assess the costs and benefits of health information technology (HIT) in an established community-wide network of academic, private and public healthcare facilities created to share clinical information for the purpose of population-based care management of over 16,000 Medicaid beneficiaries in Durham County, North Carolina. The area of interest for this application is the impact of information-driven interventions on care quality, patient safety and healthcare costs across the diverse stakeholders participating in this collaborative partnership. In order to asses HIT value rigorously in the context of a production information system that is under continual development, the applicant proposes to conduct a randomized controlled trial. Specifically, this project will randomly assign patients by family unit to either a control group or to an intervention group in which they will initially receive one of three information-driven interventions. The interventions include clinical alerts sent to care providers, performance feedback reports presented to clinic managers, and care reminders sent directly to patients. The content of the interventions will address "concerning" events (e.g., an emergency room encounter for asthma) and care deficiencies (e.g., delinquency on biannual mammogram) identified from the composite set of clinical data in our information system. To assess the benefits and burdens of the interventions, combinations of the three interventions will be sequentially introduced into the study groups over the course of the application. The analysis will compare groups receiving various combinations of interventions as well as those receiving no interventions. At baseline and at six-month intervals throughout the course of the study, the applicant will measure emergency department encounter rates, hospitalization rates, HEDIS scores, missed appointment rates, glycated hemoglobin levels in diabetics, and patient satisfaction. Assessment will look at the societal value of HIT as well as the value for individual stakeholders including patients, providers, payers, purchasers and policy makers. From these measures, the costs and benefits will be assessed of this community-wide effort to promote interoperability of clinical data exchange in order to increase the understanding of HIT value in a community setting. In preliminary studies, the applicant has observed a statistically significant three-fold reduction in repeat ED encounter rates using email alerts alone. The approach used in this application is generalizable across geographic areas and healthcare settings and can, therefore, serve to promote the dissemination of HIT to other communities.